February 2015 Guide to Providing Independent Medical Exams · adopted or the “ IME Standards ” published in OAR 436-010 Appendix C and in this guide. • Agree to abide by the

Guide to Providing Independent

Medical Exams

February 2015

Workers’ Compensation

Guide to Providing Independent Medical ExamsThe Workers’ Compensation Division (WCD) developed this guide for health care providers who want to provide independent medical exams for Oregon workers’ compensation.Oregon’s workers’ compensation system is designed to:• Prevent or reduce worker injuries and illnesses• Provideappropriatemedicaltreatmentandbenefitsto

help injured workers recover and return to work as soon as possible

• Resolve disputes quickly and fairly• Be the exclusive liability for employers and the

exclusive remedy for workers for injuries, diseases, symptom complexes, and similar conditions arising out of and in the course of employment, whether or not they are determined to be compensable under the workers’ compensation law (ORS 656.018)

What is an independent medical examination (IME)?An independent medical examination is an objective and impartial medical exam requested by a workers’ compensation insurer or self-insured employer. The insurer chooses the health care provider and pays for the exam. A health care provider other than the worker’s attending physician conducts the exam in an officeorthroughanIMEcompany.Anexamperformed by more than one health care provider, in one or more locations within a 72 hour period, is called a panel exam.

What is your role as an IME provider?YourroleasanIMEprovideristo:• Examinetheinjuredworker,butnotto

provide treatment • Remain unbiased and a neutral third party • Writeareportbasedonthefindingsfrom

the exam and medical records • Send a copy of the report to the workers’

compensation insurer

GUIDE TO PROVIDING INDEPENDENT MEDICAL EXAMS

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Who can perform an IME?HealthcareproviderscanperformIMEsoncethey complete a director-approved training to conduct independent exams for workers’ compensation claims and are placed on the director’slistofauthorizedIMEproviders.Physical therapist (PT) and occupational therapist (OT): A PT or OT may be asked to performphysicalcapacityevaluations(PCE)orworkcapacityevaluations(WCE),alongwithanIME.Inthiscase,theinsurermustusethedirector’s list to select the PT or OT.IftheattendingphysicianaskstheinsurertoarrangethePCEorWCE,orifanattendingphysicianinitiatesthePCEorWCE,youortheinsurer do not need to use the director’s list when choosing the PT or OT.

How do I become an IME provider?TobecomeanauthorizedIMEprovider,youmust do all of the following:• Hold a current license and be in good

standing with the professional regulatory board that issued the license.

• Attend a director-approved training regardingIMEsorreviewIMEtrainingmaterials approved by the director (such as this guide).

• CompletetheonlinecertificationformIndependentMedicalExamMedicalService Provider Authorization at www.oregonwcdoc.info. On the application, you must provide your license number, which will be used to verify you are in good standing with the relevant licensing board. Also, if you attend a director-approved training, you must provide to the director thedateoftheapprovedIMEtrainingandname of the training vendor.

• Agree to abide by the standards of professional conduct that either the relevant medical licensing board has adopted or the “IME Standards” published in OAR 436-010 Appendix C and in this guide.

• Agree to abide by the Oregon workers’ compensation laws and rules.

IME standards BelowaretheIMEstandardsthatyouagreetoabidebywhenyousigntheIMEproviderapplication. Please review these standards beforeconductinganIME.1. Communicate honestly with the parties

involved in the examination. 2. Conduct the examination with dignity and

respect for the parties involved. 3. Identifyyourselftotheexamineeasan

independent examining physician. 4. Verify the examinee’s identity. 5. Discuss the following with the examinee

before beginning the examination: a. Remind the examinee of the party who

requested the examination. b. Explaintotheexamineethata

physician-patient relationship will not be sought or established.

c. Tell the examinee the information provided during the examination will be documented in a report.

d. Review the procedures that will be used during the examination.

e. Advise the examinee a procedure may be terminated if the examinee feels the activity is beyond the examinee’s physical capacities or when pain occurs.

f. Answer the examinee’s questions about the examination process.

6. During the examination: a. Ensuretheexamineehasprivacyto

disrobe. b. Avoid personal opinions or disparaging

comments about the parties involved in the examination.

c. Examinetheconditionsbeingevaluatedsufficientlytoanswertherequestingparty’s questions.

http://www.oregonwcdoc.info


http://www.cbs.state.or.us/wcd/administration/SB311/ime_standards.pdf

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d. Let the examinee know when the examination has concluded, and ask if the examinee has questions or wants to provide more information.

7. Provide the requesting party a timely reportthatcontainsfindingsoffactand conclusions based on medical probabilitiesforwhichyouarequalifiedtoexpress an opinion.

8. Maintaintheconfidentialityofthepartiesinvolved in the examination subject to applicable laws.

9. At no time provide a favorable opinion based solely or in part upon an accepted fee for service.

Types of exams and the differences between them

� Independent medical exam (IME): A medical examination of an injured worker by a health care provider other than the worker’s attending physician at the requestoftheinsurer.IMEexamsmaybe performed in order to determine the compensability or causation of the injury itself; whether the treatment the worker is receiving is appropriate; and whether the worker has a measurable impairment. This does not include a consultation arranged byamanagedcareorganization(MCO)foran enrolled worker or a second surgical opinion.Insurersmustchoosefromthedirector’s list of authorized IME providers (ORS 656.325).

A physical examination by an attending physician is performed primarily for purposes of determining diagnosis and documenting the clinical course over time.TheIMEphysicalexaminationisanexamination for the purpose of objective documentation of the worker’s status. Specificmeasurementsaccordingtoaccepted protocols may be used to provide the basis for impairment ratings.

InanIME,thereisusuallyonlyoneopportunity for examination. Therefore, theIMEneedstoprovideacomplete,comprehensive, and objective description of the examinee’s condition at that time, in the context of prior health, physical and vocational capabilities, and social functioning.Incontrast,theattendingphysician’s evaluations are based on multiple, shorter encounters over the course of time. Unlike the medical consultation that ends only with treatment recommendations,theIMEisbroaderinscope.Often,theIMEwillanswerspecificquestions posed by the referring source. Referring sources include insurers and Workers’ Compensation Division.

� Worker-requested medical exam (WRME): An objective and impartial exam available to a worker whose claim has been denied based on an independent medical exam in which the injured worker’s physiciandidnotconcurwiththefindingsand the worker requests a hearing on the denial (ORS 656.325).

IftheWRMEisapproved,thedirectorchooses the physician from the authorized listofIMEproviders.Theworkerortheworker’s attorney schedules the exam. The insurer is required to send the medical records. The examiner answers the questionsaskedduringtheoriginalIME,aswell as any additional questions from the worker or the worker’s attorney.

� Medical arbiter exams: A health care provider selected by the director to perform an impartial examination regarding a disagreementoverimpairmentfindingsat claim closure. This exam helps the division’s appellate reviewer to resolve the disagreement. The reviewer asks specificquestionsrelatedtotheworker’simpairment and may ask about the portion of the worker’s impairment that is due to the accepted condition(s). Claim closure disputes do not review for compensability (ORS 656.268).

http://www4.cbs.state.or.us/ex/imd/reports/rpt/index.cfm?ProgID=CI8001


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� Physician review exam: A health care provider is selected by the director to performanexamorfilereviewforadisputeregarding appropriateness of a treatment proposed or provided. This exam helps the division’s medical reviewer to resolve thedispute.Thereviewerasksspecificquestions related to whether the treatment is appropriate given the worker’s accepted condition. Treatment disputes do not review for compensability (ORS 656.327).

Note: You do not need to be on the director’slistofIMEproviderstoperform medical arbiter or physician review exams.

How should I prepare for the exam? BeforeyouseetheworkerforanIME:• ReviewtheIMEstandardspriorto

performing the exam.• Review the questions provided from

the insurer.• Review the medical records provided to

you, including any testing and studies. Note: Ifyoudonotreceiveallthemedical records or diagnostic studies, contact the insurer.

This will provide the basis for your evaluation, highlighting the issues, and targeting your examination. YoumustmakeForm440-3923,“ImportantInformationaboutIndependentMedicalExams,”available to the worker before the exam, if asked.

CommunicationWorker and IME providerYourroleasanIMEproviderisasaconsultant,thus no physician-patient privilege exists for IMEs.Youshouldneverdiscussyourfindingsor recommendations with the worker, family members, attending physicians, or worker’s attorney. However, if a health-threatening condition is discovered during the examination, you should bring this to the worker’s attention and tell the worker to seek appropriate medical care.

To review items that you can discuss with the worker, refer to the IME Standards section of this guide. As noted in Form 3923, the worker may takeasurveyonlineabouttheIMEat www.wcdimesurvey.info.

Insurer and IME providerAllofyourfindingsshouldbecontainedinyourIMEreport,andyoucandiscussyourreportwith the insurer. AproblemforinsurersoccurswhenIMEproviders do not answer the questions. These providers either opine in areas they were not requested to address or do not answer questions. You should have a clear understanding of the questions the insurer wantsanswered.Ifyouareunclearofthequestion the insurer is asking, clarify with theinsurer.Makesureyouansweronlythequestions asked in your report.

What happens during the exam? During the exam you should:• Identifyyourselftotheworkerasan

independent examining physician. • Verify the worker’s identity. • Discuss the following with the worker

before beginning the examination: » Remind the worker of the party who

requested the examination. » Explaintotheworkerthataphysician-

patient relationship will not be sought or established.

» Tell the worker the information provided during the examination will be documented in a report.

» Review the procedures that will be used during the examination.

» Advise the worker a procedure may be terminated if the worker feels the activity is beyond his or her physical capacities or when pain occurs.

http://www.wcdimesurvey.info

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» Answer the worker’s questions about the examination process.

• Ensuretheworkerhasprivacytodisrobe.• Avoid personal opinions or disparaging

comments about the parties involved in the examination.

• Examinesufficientlytheconditionsbeing evaluated to answer the insurer’s questions.

• Let the worker know when the examination has concluded, and ask if the worker has questions or wants to provide more information.

• Remind the worker they can go online and takeasurveyabouttheIME.

Iftheworkerhasasuperimposedorunrelatedcondition, consider and describe both compensable and noncompensable conditions for overall impairment and identify impairment due to the compensable condition only.

Observers in IME exams:You must allow a worker to have an observer in the exam if the worker requests one, unless it is a psychological exam. The worker must giveyouanIMEObserverForm,whichislocatedinForm3923,“ImportantInformationaboutIndependentMedicalExamsforInjuredWorkers.” By signing Form 3923, the worker is stating that he or she understands you may ask sensitive questions during the exam in front of

the observer. You do not have to allow the observer to be present if Form 3923 is not completed and giventoyou.Iftheworkerdoesnothavetheobserver form and wants to have an observer present during the exam, give Form 440-3923, “ImportantInformationaboutIndependentMedicalExams,”totheworkerbeforetheexam.The observer cannot:• Participate in or obstruct the exam.• Be the worker’s attorney or any

representative of the worker’s attorney.• Receive compensation for attending

the exam.

Recording the examA worker may use a video camera or tape recorder to record the exam only if you approve.

Invasive proceduresInaninvasiveprocedure,thebodyisenteredbya needle, tube, scope, or scalpel.IfyouwanttoperformaninvasiveprocedureduringtheIMEyoumust:• Explaintherisksinvolvedintheprocedure.• Explaintotheworkerhisorherrightto

refuse the procedure.• GivetheworkertheForm3227,“Invasive

MedicalProcedureAuthorization.”• Give the worker a copy of the completed

form and send the original to the insurer.The worker must: • Check the applicable box on Form

3227,“InvasiveMedicalProcedureAuthorization,” either agreeing to the procedure or declining the procedure.

• Give permission by signing the form.


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InterpretersA worker may choose a person to communicate with you when you and the worker speak differentlanguages,includingsignlanguage.You may disapprove of the worker’s choice at any time you feel the interpretation is not complete or accurate. A medical provider, medical provider’s employee, or a family member or friend of the worker who provide interpreter services will not be paid by the insurer.

What if the worker is a no show?Iftheworkerdoesnotshowfortheexam,youshouldinformtheinsurer.IftheworkerfailstoattendanIMEwithoutnotifyingtheinsurerbefore the date of the examination or without sufficientreasonfornotattending,thedirectormay impose a monetary penalty against the worker or the insurer may request suspension oftheworker’sbenefits.

Worker objects to IME locationWhen the worker objects to the location of an IME,theworkermayrequestreviewbythedirector within six business days of the mailing date of the appointment notice [OAR 436-010-0265(9)].

What happens after the exam?IME reports TheIME,insomeways,islikemanyothermedical examinations (e.g., obtaining a history, performing a physical examination, and making adiagnosis).However,IMEreportsdiffer from other medical consultations and reports in several important ways:

• Content: The medical report produced by the attending physician determines the course of treatment. An independent healthcareproviderperformstheIMEattherequestoftheinsurer.TheIMEanswersspecificquestions.Becauseof

variability of the requirements in individual IMEcases,itisimpossibletodefineexactly what should be in every report.

• Proofreading: Providers often do not carefullyproofreadtheirIMEreportbeforeitisfinalized.Eachmistakemayreducethevalidity of the report and call into question the correctness and the weight of your opinions. You should try to catch and correct all misspelled words, transcription errors, and grammatical mistakes before yourIMEreportisfinalizedandsentto the parties.

• Quality assurance statement: Sign a statement at the end of the report verifying who performed the examination and dictated the report, the accuracy of the content of the report, and acknowledging that any false statements may result in sanctions by the director.

• Time frames for completion: Send the insurer a timely report that contains findingsoffactandconclusionsbasedon medical probabilities for which you are qualifiedtoexpressanopinion.

• Clear responses: Providers often will refer generally to the medical records they reviewed. This opens up endless questions about what records they did and did not review. Providers should clearly list and accurately describe all of the medical records and other documents they reviewedbeforepreparingtheirIMEreport.

• History:ThehistoryinanIMEisoftenmore comprehensive than history obtained in other medical examinations byanattendingphysician.Mostmedicalexamination history includes the usual subjective history of present illness. An IMEhistoryalsoincludesacomprehensivereview of prior medical records, and occupational and socioeconomic history. Itisimportantthatyouprovideanaccuratehistory and document it. Providers should include a thorough, well-written, and accuratehistoryasapartoftheirIMEreport. Often, providers perform a detailed

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physical examination but fail to thoroughly document the exam. Providers should checktheirIMEreporttomakesurethatall of the tests performed and all of the findingsmadeareclearlyandaccuratelydocumented in the report.

• Return to work:Itisimportanttorespondto return-to-work questions and any questions about physical limitations (e.g., a back injury with no lifting more than 20 pounds or a knee injury where the worker cannot squat or stand for more than two hours on a permanent basis). There is often a job description or job analysis withIMEsthataddressreturn-to-workstatus.Iftherearejobdutiestheworkercan and cannot perform, either for a particular amount of time or permanently, you need to put that in your report. You should let the insurer know that vocational rehabilitation is necessary if the worker no longer has the physical capability to do his or her job.

Inyourreport,answerallquestionsaskedbythe insurer. Send a copy of the report to the insurer.IncludeaQualityAssurancestatementattheendoftheIMEreport.If,afterthereportisissued,youareaskedtoprovide additional information, you should issue a supplemental report.After the report is issued, if an error is found, you may correct your report.The conventional medical report uses complex medical terminology. However, the reader ofanIMEmaynothaveextensivemedicalbackground. Therefore, the independent medical examiner should write the report so that it is understandable to the lay reader.

Who do I bill for the independent medical exam?You bill the workers’ compensation insurer or self-insuredemployerusingOregon-specificcode D0003.

Complaint process and what the IME provider should expectAfteraworkerhasattendedanIME,acomplaintmaybefiledonlineatwww.wcd.oregon.gov, or in writing to the director for investigation. The director will determine the appropriate action to take in a given case. During the investigation the director may contact you regarding the allegation.

Criteria for removal of health care providers from the list of approved IME providers A provider may be sanctioned or excluded from the director’s list of providers authorized to performIMEsafterafindingbythedirectorthatthe provider did any of the following:• Violated the standards of either the

professionalconductforperformingIMEsadopted by the provider’s regulatory board or the independent medical examination standards published in Appendix C to the Division 010 rules

• Failed to comply with the requirements of OAR 436-010-0265, as determined by the director

• Has a current restriction on his or her license or is under a current disciplinary action from his or her professional regulatory board

• Enteredintoavoluntaryagreementwithhis or her regulatory board that the director determines is detrimental to performing IMEs

• Violated workers’ compensation laws or rules

• Failed to complete an approved training required by the director

Within 60 days of the director’s decision to exclude a provider from the director’s list, the provider may appeal the decision under ORS 656.704(2) and OAR 436-001-0019.

http://www.wcd.oregon.gov

http://www.wcd.oregon.gov


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Terms used in workers’ compensation accepted conditionA medical condition for which an insurer accepts responsibility for the payment of benefitsonaclaimfiledbyaninjuredworker.The insurer provides written notice of accepted conditions (ORS 656.262). The insurer generally willacceptspecificconditionsbasedonthediagnosis by the physician or nurse practitioner. Itisimportantthatthehealthcareproviderreport a diagnosis rather than a symptom.

aggravation claimAclaimforfurtherbenefitsbecauseofaworsening of the claimant’s accepted medical condition after the claim has been closed. An aggravation is established by medical evidence supportedbyobjectivefindingsobservedor measured by the physician. Aggravation rightsexpirefiveyearsafterfirstclosureondisablingclaimsorfiveyearsfromdateofinjury on nondisabling claims (ORS 656.273). AnattendingphysicianwhoisanMDorDOmustfileForm827andamedicalreportwiththeinsurerwithinfiveconsecutivecalendardays of the worker’s visit to make a claim for aggravation. The insurer has 60 days to accept or deny a claim for an aggravation.

ancillary careCare such as physical or occupational therapy provided by a health care provider other than the attending physician, specialist physician, or authorized nurse practitioner.

apportionmentAdescriptionofthecurrenttotaloverallfindingsofimpairmentandthosefindingsthataredueto the compensable condition when there is impairment due to the accepted condition and other unaccepted conditions. Describe specificfindingsthatarepartiallyattributableto the accepted condition, and any applicable superimposed or unrelated conditions.

Example: Seventy-five percent of the decreased range of motion is due to the accepted condition and any direct medical sequela, and the remaining percentage is due to pre-existing degenerative joint disease.

attending physician (AP)A physician primarily responsible for the treatment of an injured worker (ORS 656.005).

bulletinAnofficialagencycommunicationinforminginsurers or others regulated by DCBS of new information, processes, or requirements.

claimA written request by the worker or on the worker’s behalf for compensation (ORS 656.005). The insurer has 60 consecutive calendar days from the employer’s date of knowledge to accept or deny the claim. (See also disabling claim and nondisabling claim.)

claim disposition agreement (CDA and C&R)The written agreement as provided in ORS 656.236 in which a claimant agrees to release rights, or agrees to release an insurer or self-insured employer from obligations, under ORS 656.001 to 656.794, except for medical services, in an accepted claim. The term “compromise and release” has the same meaning.

closing examinationA medical examination to measure impairment, which occurs when the worker is

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medically stationary.

combined conditionA combined condition occurs when a pre-existing condition combines with a compensable condition. A combined condition may cause disability or prolong treatment. However, a combined condition is only compensable if the compensable injury is the major contributing cause of the disability or the need for prolonged treatment.

Example: A worker has arthritis of the knee and then sustains a job-related injury to the same knee. The acute condition is diagnosed as a sprain. Both conditions contribute to the worker’s disability. The combined condition is compensable only if the compensable injury (the sprain) contributes more than 50 percent to the worker’s disability or need for treatment.

compensable injuryAn accidental injury to a person or prosthetic appliance, arising out of and in the course of employment that requires medical services or results in disability or death (ORS 656.005). A claim is compensable when the insurer accepts it.

consequential condition or diseaseA condition arising after a compensable injury of which the major contributing cause is the injury or treatment rendered that increases either disability or need for treatment (ORS 656.005). A consequential condition is only compensable if the compensable injury or disease contributes more than 50 percent of the worker’s disability or need for treatment.

Example: Use of crutches due to a compensable knee condition may cause a consequential shoulder condition that requires treatment or leads to disability.

consulting physicianA physician who advises the attending physician or authorized nurse practitioner regarding the treatment of a worker’s injury. A consulting physician is not considered an attending physician, and, therefore, the worker should not complete Form 827 for the consultation.

curative careIntheworkers’compensationsystem,treatment to stabilize a temporary waxing and waning of symptoms after a worker is medically stationary (ORS 656.245).

denied claim (denial)A written refusal by an insurer to accept compensability or responsibility for a worker’s claim of injury (ORS 656.262). On accepted claims, the insurer may deny certain conditions only; this is known as a partial denial. Only a worker can appeal a denial of a claim.

disabling claimAnyinjuryisclassifiedasdisablingifitcausesthe worker temporary disability (time-loss), permanent disability, or death. The worker willnotreceivetime-lossbenefitsforthefirstthreedaysunlessheorsheisoffworkandnotreleasedtoreturntoanyworkforthefirst14consecutive days or is admitted to a hospital as aninjuredworkerduringthefirst14consecutivedays.Theclaimisalsoclassifiedasdisablingif there is a reasonable expectation that permanent disability will result from the injury.


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Form 801 — First Report of InjuryOfficialstateformusedbyworkersandemployers to report occupational injury or disease.

Form 827 — Worker’s and Physician’s Report for Workers’ Compensation ClaimsForm used by workers and physicians to report toinsurers.Includesfirstreportofinjury,reportof aggravation, notice of change of attending physician, progress report, closing report, and palliative care request.

health care providerA person duly licensed to practice one or more of the healing arts.

impairment findingsAdescriptionofallimpairmentfindingsthatare permanent and due to the accepted condition, and any direct medical sequela. A medical opinion addressing the validity of the impairmentfindings,withafullexplanationbased on sound medical principles, stating why thefindingsarevalidorinvalid.

initial claimThefirstopenperiodontheclaimimmediatelyfollowingtheoriginalfilingoftheoccupationalinjuryordiseaseclaimuntiltheworkerisfirstdeclared medically stationary by an attending physician or authorized nurse practitioner.

major contributing cause (MCC)A cause deemed to have contributed more than 50 percent to an injured worker’s disability or need for treatment.

managed care organization (MCO)An organization that may contract with an insurer to provide medical services to injured workers (OAR 436-015, ORS 656.260).

material causeSubstantial cause, up to 50 percent, compared to all other causes combined.

medical sequelaAlso known as direct medical sequela, it is a condition that is clearly established medically and originates or stems from an accepted condition.

Example: The accepted condition is low back strain with herniated disc at L4-5. The worker develops permanent weakness in the leg and foot due to the accepted condition. The weakness is considered a direct medical sequela.

medical serviceMedical,surgical,diagnostic,chiropractic,dental, hospital, nursing, ambulance, drug, prosthetic, or other physical restorative services (ORS 656.245).

medically stationaryThepointatwhichnofurthersignificantimprovement can reasonably be expected from medical treatment or the passage of time (ORS 656.005).

new medical condition claimA worker’s written request that the insurer accept a new medical condition related to the original occupational injury or disease. Medicalservicesfornewconditionsarenotcompensable unless conditions are accepted.

Example: An initial diagnosis of low back sprain/strain results in the acceptance of that condition. After further diagnostic studies, a herniated disk is diagnosed and the injured worker makes a new condition claim in writing for that herniated disk.

nondisabling claimAninjuryisclassifiedasnondisablingifitdoesnot cause the worker to lose more work time than the three-day waiting period or it requires medical services only, and the worker has no permanent impairment (ORS 656.005).

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objective findingsIndicationsofaninjuryordiseasethataremeasurable, observable, and reproducible; used to establish compensability and determine permanent impairment (ORS 656.005).

Examples: Range of motion, atrophy, muscle strength, palpable muscle spasm, etc.

occupational diseaseA disease or infection arising out of and occurring in the course and scope of employment.Itiscausedbysubstancesoractivities to which an employee is not ordinarily subjected or exposed to other than during employment and requires medical services or results in disability or death. A mental disorder, or physical disorder caused or worsened by job-related mental stress, also may be an occupational disease.Ifanoccupationaldiseaseclaimisbasedon a worsening of a pre-existing disease or condition, the employment conditions must be the major contributing cause of the combined condition and pathological worsening of the disease.

omitted medical condition A worker’s written request that the insurer accept a medical condition the worker believes was incorrectly omitted from the Notice of Acceptance.Medicalservicesforomittedconditions are not compensable unless conditions are accepted.

palliative careMedicalservicesrenderedtoreduceortemporarily moderate the intensity of an otherwise stable condition to enable the worker to continue employment or training (ORS 656.005, 656.245). (See also the back of the Form 827.)

partial denialDenial by the insurer of one or more conditions of a worker’s claim, leaving some conditions of the claim accepted as compensable.

permanent partial disability (PPD)The permanent loss of use or function of any portionofthebodyasdefinedbyORS656.214and OAR 436-035.

physical capacity evaluation (PCE)The measurements of a worker’s ability to perform a variety of physical tasks.

precipitating causeImmediatetemporalrelationshipbetweenworkactivities and onset of symptoms; not always the major cause.

pre-existing conditionA condition that existed before the compensable injury or disease.

prosthetic applianceTheartificialsubstitutionforamissingbodypart, such as a limb or eye, or any device that augments or aids the performance of a natural function, such as a hearing aid or glasses (ORS 656.005, 656.245).

regular workThe job the worker held at the time of injury or a substantially similar job.


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release of medical recordsFiling a workers’ compensation claim authorizes health care providers to release relevant medical records to the insurer, self-insured employers, or the Department of Consumer and Business Services. The privacy ruleofHIPAAallowshealthcareprovidersto disclose protected health information to regulatory agencies, insurers, and employers as authorized and necessary to comply with the laws relating to workers’ compensation. However, this authorization does not authorize the release of information regarding the following:• Federally funded alcohol and drug abuse

treatment programs.• HIV-relatedinformation.

» HIV-relatedinformationshouldonlybe released when a claim is made for HIVorAIDSorwhensuchinformationis directly relevant to the claimed condition.Note: Any disclosures to employers arelimitedtospecificpurposes,suchasreturntoworkormodifiedwork.

specialist physicianA specialist physician is a physician who qualifiesasanattendingphysicianbutdoesnotassume the role of attending physician.A specialist physician examines the worker or provides specialized treatment, such as surgery or pain management, at the request of the attending physician or authorized nurse practitioner. During the time a physician provides specialized treatment, the attending physician continues to monitor the worker and authorizes any time-loss.

temporary partial disability benefits (TPD)Payment for wages lost based on the worker’s abilitytoperformtemporarymodifiedorpart-time work due to a compensable injury. (See alsotime-lossbenefits.)

temporary total disability benefits (TTD)Payment for wages lost based on the worker’s temporary inability to work due to a compensable injury. (See also time-lossbenefits.)

time-loss authorizationWhen an attending physician authorizes time-loss, the insurer may request periodic progress reports. Form 827 is not required if the chart notes provide the information requested.

time-loss benefitsCompensation paid to an injured worker who loses time or wages because of a compensable injury. A worker who is not physically capable of returning to any employment is entitled to benefitsfortemporarytotaldisability(time-loss).Aworkerwhocanreturntomodifiedworkmaybeentitledtobenefitsfortemporarypartial disability if his or her wages or hours of modifiedworkarereduced.

work capacity evaluation (WCE)See physical capacity evaluation.

Workers’ Compensation Board (WCB)The part of the Oregon Department of Consumer and Business Services responsible for conducting hearings and reviewing legal decisionsandagreementsaffectinginjuredworkers’benefits.

Workers’ Compensation Division (WCD)The division within the Oregon Department of Consumer and Business Services that administers Oregon’s workers’ compensation laws.

WorseningActual worsening of underlying compensable condition.Increasedsymptomsmaysignifyworsening. A worsening must be established by persuasive medical opinion and is supported byobjectivefindings.

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History of IME authorizationThe Workers’ Compensation Division (WCD) conducted a study of independent medical examinations(IMEs)inOregon,attherequestoftheManagement-LaborAdvisoryCommittee(MLAC).Thestudyincludedsurveysofinjuredworkers,attendingandIMEhealthcareproviders,workeranddefenseattorneys,andIMEfacilities.Focusgroupswereheldtogetinsurerandthird-partyadministratorinput.WCDmaderecommendationstoMLACandasaresult,SenateBill311was created. The 2005 Legislature unanimously passed Senate Bill 311. The bill:• Requires health care providers to be authorized by the director of the Department of Consumer

andBusinessServices(DCBS)toconductIMEsforworkers’compensationclaimsinOregon.• RequiresWRMEproviderstobeselectedfromanIMElistofauthorizedproviders.• RequiresaQualityAssurancestatementattheendoftheIMEreport.• Provides the worker an opportunity to request review by the director of the reasonableness of

thelocationselectedfortheIME.• ImposesamonetarypenaltyagainstaworkerwhofailstoattendanIMEwithoutprior

notificationorwithoutjustificationfornotattending.• Imposesasanctionagainstahealthcareproviderwhounreasonablyfailstoprovidediagnostic

recordsrequiredforanIMEinatimelymanner.• Provides the director of DCBS authority to investigate complaints and exclude a health care

provider if they violate standards of professional conduct.

How do I apply to become an IME provider?Once you have read this guide, go to www.oregonwcdoc.info to complete the application.


Phone numbers

Medicalservice/feeinfo .............. 503-947-7606MCOinformation ..........................503-947-7697Workers’ Compensation

InformationLine .....................800-452-0288 *InjuredWorkerHelpLine

(Ombudsman) ..........................800-927-1271 *EmployerIndex .............................503-947-7814Investigations–FraudHotline .....800-452-0288WCD Publications ........................503-947-7627*Spanish-speaking help lines are available.

WCD websiteOregon Workers’ Compensation Divisionwww.wcd.oregon.gov or www.oregonwcdoc.info

These topics can be visited (and bookmarked) from our main page: Health Care Providers ManagedCareOrganizations Laws & Rules Bulletins (includes forms) InformaciónenEspañol

Resources

File ➜ Within

New injury or disease ➜ 3 days of treatmentNew attending physician ➜ 5 days of treatmentAggravation of ➜ 5 days of treatment existing injury Send closing report ➜ 14 days of date to insurer declared medically stationary

TimeframesforfilingForm827

440-4913 (2/15/COM)

How to Find Workers’ Compensation Coverage Information

For your information about Workers’ Compensation

� First — Call the employer for information about insurance coverage.

� If you need more help — ContacttheEmployerComplianceUnitoftheWorkers’ Compensation Division (WCD) by phone,fax,e-mail,orInternet.

» Phone: 503-947-7815 » Fax: 503-947-7718 » E-mail:[email protected] » Internet:www.wcd.oregon.gov, under“BusinessTools,”clickon“EmployerCoverage.”

� Provide this information to WCD:

» Employer’slegalbusinessname, street address, city, and phone number.

» Coverage inquiry date. » Worker’s name.

� If necessary, the Employer Compliance Unit will conduct further research.

� Please send a copy of Form 827, “Worker’s and Health Care Provider’s Report for Workers’ Compensation Claims,” or Form 801, “Report of Injury or Illness” to:

» Workers’ Compensation Division » EmployerComplianceUnit » P.O. Box 14480 » Salem, OR 97309-0405

www.wcd.oregon.gov

www.oregonwcdoc.info

mailto:[email protected]

www.wcd.oregon.gov

February 2015 Guide to Providing Independent Medical Exams · adopted or the “ IME Standards ” published in OAR 436-010 Appendix C and in this guide. • Agree to abide by the

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